DR. SAM ENOCH PRUETT JR. (NPI# 1396991899) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396991899 |
| Entity Type | Individual |
| Full Name | DR. SAM ENOCH PRUETT JR. |
| Practice Address |
2816 Bunny Ln Sw Decatur AL 35603-4250 |
| Practice Telephone | 2563552382 |
| Practice Fax Number | 2563552382 |
| Mailing Telephone | 2563552382 |
| Mailing Fax Number | 2563552382 |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2008-08-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
2246 | AL | Dental Providers |
| Street Address |
2816 BUNNY LN SW |
| City | DECATUR |
| State | AL |
| Zip Code | 35603-4250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043858848 | Marcanna Michele Kimball | Technician | 1616 Saginaw Ln Sw, Decatur, AL 35603 | 2019-12-12 |
| 1316503808 | Julie Monteiro-pai | Nurse Practitioner | 2828 Us 31, Suite # 117, Decatur, AL 35603 | 2019-05-10 |
| 1700305372 | Jessica Skarda | Nurse Practitioner | 1577-1631 Kathy Ln Sw, Decatur, AL 35603 | 2017-09-14 |
| 1841532546 | Priceville Pharmacy LLC | Pharmacy | 2941 Point Mallard Pkwy, Suite A, Decatur, AL 35603 | 2013-03-20 |
| 1235392689 | David Gerardo Barraza | Nurse Practitioner | 2422 Donville Road, Suite E, Decatur, AL 35603 | 2008-07-07 |
| 1164629002 | Rachel E. Kennedy | Family Medicine | 2422 Danville Rd., Suite E, Decatur, AL 35603 | 2007-07-02 |
| 1558583708 | Active Physical Therapy, Inc. | Clinic/Center | 2424 Danville Rd. Sw, Ste M, Decatur, AL 35603 | 2007-05-03 |
| 1598829814 | Decatur Eye Institute | Optometrist | 2620 Centron Dirve Sw, Decatur, AL 35603 | 2006-12-21 |
| 1447326442 | Joseph R Dupper | Podiatrist | 2506 Danville Rd Sw Suite 204, Decatur, AL 35603 | 2006-11-28 |
| 1568531820 | Highlands Internal Medicine LLC | Internal Medicine | 2422 Danville Rd, Suite F, Decatur, AL 35603 | 2006-11-08 |
| Find all providers in zip 35603 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033328349 | Jurgens & Kneezel Ltd | Dentist | 334 W Main Street, Decatur, IL 62522 | 2007-05-22 |
| 1255543161 | William Floyd Littlejohn Jr. | Dentist | 2023 Danville Park Dr Sw, Decatur, AL 35603-1833 | 2007-05-04 |
| 1740371905 | Randy Curtis Kneezel | Dentist | 334 W Main, Decatur, IL 62522 | 2006-09-27 |
| 1700822020 | Michael Shane Stevenson | Dentist | 1401 Stratford Rd Se, Decatur, AL 35601-6022 | 2006-06-22 |
| 1922056282 | Leroy Loving Jr. | Dentist | 2352 Candler Rd, Decatur, GA 30032-6406 | 2006-05-05 |
| 1215164124 | Jennifer Dawn Okhiria | Dentist | 200 E Ponce De Leon Ave, Decatur, GA 30030 | 2009-06-18 |
| 1477711786 | Georgia Oral Surgery | Dentist | 755 Commerce Dr, Suite A, Decatur, GA 30030-2627 | 2008-05-23 |
| 1558498295 | John Howard Muse | Dentist | 755 Commerce Dr, Suite A, Decatur, GA 30030-2627 | 2007-02-28 |
| 1831257120 | Gillian C Jones | Dentist | 200 E Ponce De Leon Ave, Ste 300, Decatur, GA 30030-3469 | 2006-12-05 |
| 1467522466 | Alan Russell Jurgens | Dentist | 334 W Main, Decatur, IL 62522 | 2006-11-08 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.